The Addicted Brain: What's in This Book, and Why Should I Read It?

Michael Kuhar introduces his book, which is about alcohol, nicotine, and illegal drugs—how they work, what they do to the brain, and what can be done to stop using them. The book is especially about what happens inside the brain and why the brain just happens to be set up for drugs.

This chapter is from the book

"I'm only 14 years old and I'm in a drug counselor's office. I've been stealing, missing school, and failing most of my subjects. It seemed to start when I got involved with drugs. We got dope from older brothers and sisters, from parents' medicine cabinets, and on the streets. We never thought of it as 'doing drugs.' We were just having fun and hanging out, and we thought we could stop anytime. But we fooled ourselves. It caught up to us big time. Now I need to find out about what happened and what I can do to turn my life around. I need to know everything!"

Getting hooked on drugs is a sequence of attraction, seduction, compulsion, and pain. Drugs are dangerous and widespread, and dealing with them requires knowledge and help. This book is about alcohol, nicotine, and illegal drugs—how they work, what they do to the brain, and what can be done to stop using them. The book is especially about what happens inside the brain and why the brain just happens to be set up for drugs. Yes, the brain is set up for drugs; the brain is a co-conspirator, albeit an unwitting one!

When is someone a drug abuser or an addict?1 If someone uses drugs casually and infrequently without significant problems and can take them or leave them, that person might best be called a user, which is still a dangerous situation. If taking drugs causes significant distress and problems in the person's life, then abuser might be the best descriptor. If drugs are in control of a person's life, or if they can't stop, or if they do drugs in spite of personal distress and negative consequences, then they might be drug dependent or addicted. Even people who are not users, abusers, or addicts are very likely to gain from reading this book.

The text box that follows provides definitions of specific levels of drug use. Addiction is the most serious form of the disorder2 and it can develop when drugs are taken repeatedly over a long period of time. Taking larger quantities of drugs more frequently is likely to result in addiction more quickly. However, there is no mathematical equation describing this process. It is not exact. Moreover, the process varies depending on the individual and his or her circumstances.

Definitions

DSM IV TR is the latest edition of the Diagnostic and Statistical Manual of Mental Disorders that is published through the American Psychiatric Association. It is the official manual for defining and diagnosing the spectrum of disorders that involve drug use. It is used by professionals to more precisely define the degree of drug abuse. Please see this manual for the official definitions.3

Drug use can refer to any use of a drug, but more often, it refers to an occasional or recreational use of drugs. In this case, acute or immediate effects and toxicities can be significant. If the drug used is an illegal one, then there is the legal transgression to be concerned with, too. Also, there is the danger of continued use of drugs to where they become a more serious problem.

Drug abuse is a more serious problem where there is a greater degree of drug use and a distressing or negative impact on the drug user's life. It can get further out of control.

Addiction or dependence is yet more serious and includes more of a loss of control over drug seeking and drug taking in spite of distress and/or negative consequences. Note that both loss of control over behavior and distress or negative consequences are emphasized. But, there are additional characteristics of drug addiction that are well known. Considerable time may be spent getting and using the drug. More drug is taken than intended. Efforts to stop taking the drug often fail. Tolerance, which is the need to take larger quantities of the drug to get the same effect, develops. Also, perhaps there are withdrawal symptoms when the effect of the drug wears off. Thus, an individual might have a problem with drugs even though there are no distressing feelings or negative consequences that are evident. The words addiction or dependence are used to refer to more severe cases of drug seeking and taking.

The use of drugs is not simply a passing fad or the latest, cool thing. Drugs of one type or another have been with us for a long time, literally thousands of years. Opium has been used in China for centuries, and cocaine use in early Indian cultures goes back centuries. There is even a reference in the Bible about getting drunk on wine. There are things about both the nature of drugs and the human brain that make drug use enduring over the ages, and this reveals a special vulnerability in humans. For example, in 2006-2007 in the United States, there were more than 22 million people, 12 years of age and older, who were classified with drug abuse or drug dependence on illicit drugs4 or alcohol.

What is it about addiction that grips certain individuals so firmly that they lose at least some control over their drug taking and sometimes over their lives? This book attempts to answer this question by examining research discoveries from the previous couple of decades. Extraordinary progress has been made in drug abuse research.

What Is a Drug?

When talking about drugs that can be abused, there are about seven different groups of substances. These are nicotine; sedatives such as alcohol, barbiturates, benzodiazepines, and inhalants such as fumes from glue; opiates such as heroin and morphine; psychostimulants such as cocaine, amphetamine, and methamphetamine; marijuana; hallucinogens; and caffeine. Prescription drugs that are abused comprise many of the previous classes and are shown in the following list:

Club drugs, which includes:

GHB (Also known as Goop)

Ketamine (Also known as K)

MDMA (Also known as E)

Rohypnol (Also known as Roofies)

Cocaine, which is also known as nose candy, C, and blow

Crack (another form of cocaine, and also known as Freebase, Rooster, and Tornado)

Why are these groups of chemicals addicting? It is striking how they can have such different effects and uses; for example, opiates relieve pain, and sedatives produce sleep, yet both have the danger of addiction. What is it about these chemicals, and not others, that give them such power? A reasonable answer is that it is an accident that all these particular compounds are addicting. There are, perhaps, millions of chemical compounds on this earth, and it is, perhaps, just unfortunate that some of these chemicals can hook into the brain in such a way that they become addicting. Of course, some of these drugs are used more than others (see Figure 1-1).

Figure 1-1 The number of individuals, ages 12 or older, who have used the indicated drug within the past 12 months (in millions). Psychotherapeutics refers to prescription drugs that were abused; these drugs include Oxycontin, Vicodin, amphetamines, Ritalin, and sedatives. These numbers of users, which range from 200,000 to over 15 million, are small compared to the number of individuals using the legal drugs, like alcohol and nicotine. More than 50 million people smoke, and an even larger number take alcohol regularly. The relatively larger use of alcohol and nicotine are probably due to the legality of these drugs and their greater availability. Legal drugs are used probably ten times more than illicit ones.(Source: SAMSHA, 2008, National Survey on Drug Use and Health, September 2009).

It is useful and can eliminate confusion to make a distinction between the words drugs and medications. The word drug is used in this book to refer to a substance with the potential to cause harm, abuse, and addiction. Of course, there are other drugs that are therapeutic, cure diseases, and are employed by doctors to treat specific maladies. These latter substances are referred to herein as medications. Drugs of abuse can also have legitimate uses in medicine and be medications. Cocaine is a powerful vasoconstrictor in that it closes off blood vessels and can be used to reduce bleeding in surgery. Amphetamine is a stimulant and can be used to treat Attention Deficit Hyperactivity Disorder (ADHD). Opiates are indispensable in the treatment of pain, but they can cause addiction nonetheless. Depending on how and why they are used, many of the substances can be both drugs and medications. Prescription drugs are another example of this; they are medications that can be abused and therefore are also drugs.